Authors: Benoit, A.C., Younger, J., Beaver, K., Jackson, R., Loutfy, M., Masching, R., Nobis, T., Nowgesic, E., O’Brien-Teengs, D., Whitebird, W., Zoccole, A., Hull, M., Jaworsky, D., Benson, E., Rachlis, A., Rourke, S., Burchell, A.N., Cooper, C., Hogg, R., Klein, M., Machouf, N., Montaner, J., Tsoukas, C., Raboud, J., on behalf of Building Bridges and the Canadian Observational Cohort (CANOC) Collaboration
Background: This study compared time to virologic suppression and rebound between Indigenous and non-Indigenous individuals living with HIV in Canada initiating combination antiretroviral therapy (cART).
Methods: Data were from the Canadian Observational Cohort collaboration; 8 studies of treatment-naïve persons with HIV initiating cART after 1/1/2000. Fine and Gray models were used to estimate the effect of ethnicity on 1) time to virologic suppression (two consecutive viral loads (VLs) <50 copies/mL at least three months apart) after adjusting for the competing risk of death and 2) time until virologic rebound (two consecutive VLs >200 copies/mL at least three months apart) following suppression.
Results: Among 7,080 participants were 497 Indigenous persons of whom 413 (83%) were from British Columbia. The cumulative incidence of suppression one year after cART initiation was 54% for Indigenous persons, 77% for Caucasian and 80% for African, Caribbean, or Black (ACB) persons. The cumulative incidence of rebound one year after suppression was 13% for Indigenous persons, 6% for Caucasian and 7% for ACB persons. Indigenous persons were less likely to achieve suppression than Caucasian participants (aHR=0.58, 95% CI: 0.50-0.68), but not more likely to experience rebound (aHR=1.03, 95% CI: 0.84-1.27) after adjusting for age, gender, injection drug use, men having sex with men status, province of residence, baseline VL and CD4 count, antiretroviral class and year of cART initiation.
Conclusions: Lower suppression rates among Indigenous persons suggest a need for targeted interventions to improve HIV health outcomes during the first year of treatment when suppression is usually achieved.